HomeMy WebLinkAbout002-940-04-3408-SAN-2022-065 � �
r�� � '
�� � Cour.ty �
; �f��. � :ndu5.ry Services Divis:on 54 w -e � �
I , ' ,
as ., � � '1400=�las!':ingt0�:�1vE S2n:2ry?em;t Nurnbe*(to be fiiled in o7
,� � F � ?A. Box?152 �
,i �``� _�f i Madiscn,WI 53?C7-7?o2 � t�' �,�� lJ ���� N
i
�
{ -� Srate Tzns2ctian Number a
� ��.��itary Pe�n�� Applicatiorl , �.
in accordance�it�SPS 38321(2).Wis.Adm.Code,subaission af this form to the appropriax goYemmenta!ur.it I V�
is rCqui;Cd pr.oi TA Obiaining a sar.iizry pc*.^.it. No:G:Agelicztion°or.ns`or sate-o���r��PbWI'S 2re sabr..i*.rrd to ?rojact Add^�s(if different shan r.+ailing
ttte Dr,anr,unt of Saiery and?;a:essionai Servia. ?_rsonzl�::;ocmation you provide,raay3e used fa.*srondary
au in aaordanu wiFh the?riv Law.5.1 S.04f 1 m).Stau. � r0�� ( K Q�
i. A iication Infora�aEioa-Pieasc Prini Alf.nformation �"
property Owntr's Name I Parcel�
l� g L�.►�. L L C � fjoZ —�i4 O-O�—.3�to S
?roperty Owtt_r's?�aili^g A�dreSS ?raoerty j„pczdpn
� n s� � n,1 0` 8 r��� 9� ; l� 2..�1 ' �0�-4:�t
IC'in•,S�tc i Zip Code � ?hone Nu•r.be: 5� �� , p�
t�a �.J4`n-� �.c) ' S���3 b3R� SW �s Section
� � 1 I (�OZ_cj D Z— {circ!e on_}
i : �0 x; R��or�
( FI.I'yge of Buiidiag(ctseei:s�l that apply) Loc r
�! ;or2ramilyJweiiing-Numbero:`3eC�or.^s � I � 3ubdi�isionName �
�
I Block r
❑PubiiGCom:nerciai-Desa';be Use �
� �Ciy of
❑S�a�e Qvm.ed-Desaibe Use i CSM Ivumber ❑Viltage of
! 37 zuz ���7 ��To�,of a�ss �. e
�
�I1.Type of Perrnit: (Check oaiy ont boz on t'sne A. Complete line B if appiicable)
A' I �?�8w$yStem I �Replzcem�t Syst�n � L;*ear.tientlFioidir.g T2nk Repiace;r�:;O:dy � �Otha Modifica�on to Existing Sys:em(expiain)
8. U?ermit Renewai � �?ermu Revision � L Change oi?tus.^.ber ;:.t?axr:it Tzsisfa to Ntw Lisi Pmious Paasit Number and Daze Issued �
Before'rxpisarion Owna �—
FV.T• of POW?S S rsi/Cora eatlDevice: ChCC1t sii L582 8 I
�Non-Pressi:rized in-CKourd u?;ess��in-Groazd J nt-Crzde J Mo:md>2<i::.of ua�te soi? ❑Niound<24 ia of suirabie Soil
�Hold;ng T�k ❑Offier Dis�sat Component(expi2in; J Pr�rzz+anen:�evice(expiain)
v.Dis ir!'restaeeac Ana Inforruation:
DLSI�YIOW�{p�Q� Design Soil Appli�tiar.��7esf? , �isve;sr!A::�Rquired(� � Dispasai Area Proposed{s� Sysum Elevazion
450 .� ; ��3 � 6R' I �3�Z�
VI.Taak Info l CapaciN, i^ .Tetzi �of � Manuiacturer
=
� Gailons j Gallo:u Ur.its D � I °� I =
r 1vewTxss:$ I :x:s:r.g?�:ks i i u o d � � � 6 �
� � a U rn ti y _C� a
I
�
�;� :�o��R�r�,� � � o O O i ` 1060 ! W �e s e�- X
D��c� �
�7T.ResponsibiIity Stzument-F,.me undersigaed,assume respoas�biliry for i�5ta3iatioa of the Pf?Wf3 si�o*'D oa ihe aCal�ed p12ti5.
� ?lur,.ber's Name;?r;nt) ?iL'�7lbGf's 5i�ture M'/l�RS Number Business Phone Number
� �o� L-c� �c� � I Z.z(PZ� 8 �-!r S-6R�-?-z�3�v
� Plumber's Address(Sreet,Ciry,State,Zie Code;
i 14s►� „� �-. c��►`1 �-4� ,,���-d w � s �S 43
VIII. o atv/De artmmt Use Oalv
�Ap'( L DisagQroved ?ermitree �il i Datessuec : :ssx�:gAg�Signawre I
�.Owner Givm�msoa fo-Der.ia3 j ��� ' �� � /�.'L ����•�C'`-���^��~
IX.Coadit'soas of Agprovad!l2easons for DisapprovaI D '
� -
�
� ��
A` C C S T 2 2- 0��t � MAY 0 3 2022
I
ASYse3 to comnitse plaat for sbe systec aad subm:t to!he CO�mt±�oah'oa paper=e!fea tam 8 UZ z i I a:e.'tes ia sizt s'A
ZON!fvG ADMl��15TRATION
SBD-o3ss(Ro3 i3; NO�E pF pE M17
PAGE 1 OF 4•
�r�-taro�nd C�ravity Pian
lndex � �over Sheet
Component Manua!Design References:
Versior 2.0, SBD-10705-P (N.01/01, R. ?0/12). -�
Pg 1 of 4 Index & Cover Sheet
Pg Z of 4 Plot Plan
Pg 3 of 4 �ispersal Area Cross-Section & Plan View
Pg 4 0�� Management Plar
Attachments: j Encios�€res:
i rOVVT� ���lica�iQ� for Review
Soil Evaluation Report & Site Map
I
�
Project Name / Description
Owner Name(s): ab �.an,�. Ll-� Phone: 6DZ- �-loZ_ �34 I
Owner Address: �056�n� p�g��e,� ��(,( (Z� {���,�.�1 W ( Zip: S`t $�
Project Address: o� Q cb d; (...n, f-��.ti w���
Govt. Lot: 5� �/4 ofSW 1/4, Section O� , T �-(�0 N-R�_E❑or W �
Township: ��,ss �,�-ke County: 54.w�, �e �--
ProjectParcellD #: ODZ -- R�fo — 04 -- 3�{Dg
Designer Information
Designer Name: �o�, La �rt'P Phone: ��S - 6��-[ - �! 3 (o
Designer Address: �`��S �L U) S'�• (L�- � ��,w4��- w� Zip: �`�'�`f3
E-maiL _
License Number: �Z(p Z- 1 �
Remarks:
Signature: �C+��' �� Date: ��3�`;0`L2—.
Original signature required on eact�submitted copy.
Qt,c�v�er ', L�41.
� � L a n � �--�—C �wc,��e r CO- � ��S S �..,� K-2 �� -
10561 (�1 � �r�e.,,, f+� (( �� Pc►�J =� ooz-R�FO - o�-f-- 3�fvS
�{�-..��ar�� � f �`�8�(3 SEISW S`� O�-f T �FO �J 2n�'t l�
6 0 2.-- `t o Z- 63 � [ Lo't' Z.
±L4D
�
�c r
�'!'GGc�� � = C'{�
o �� ?-o io 1{O
�
$ #SGcL��G �vt ���Q M
� a-1
-+-1 a.+ti�-So: �, t� Ccre�i avt Ir.� I
wl
,9
Ev.
Z
�Q� -3 � Z Q�I T r "i O` • �K
� ' o
$f1100 �
3 b�
gar� �qo
���t�Je�� � (
Ya�k
� .�, ,�
► �
� o
� -
+ zao j
. �roc�.t L n 2.
/�L�6 � �
� $f�\bb� 3flft V� � Si�P �6� �a.�rY1.P t.y�r,�6�S
�
�I . �6.3,
Z �c b-o5'
3. �b.�t
�
.�l So•�5� Sc,�s'�.c�, �i�:Z5
� r� G at' — S3.S' �
IN-GR4UND GRAVITY DISPERSAL AREA SepllcTank(s)Manufaclurer:
I,�J i e se�-
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ffi Trench (down-sizing credit) SPP"�T�nkcs'�o�Ume�s�: '
'��Uga1 qal gal gal
y �� ' 1�. � Eflluent Fflter Manulacturer: :
- SOIL COVER �— � �a � �''— — —
- - m1n.12"
- (ryp�caq Et(luent Pllier MocJel fl: S Z�
1?.° ------------- — —
min.lrench
TYPICAL TRENCH �i�n,n ^ �`_ �
CROSS SECTION VIEW ��Y��ca�� � '•�. � ��
• — - ___.____ _ --- .. . .•4•• • Provide minimum 3 ft '
(No Scale) . �. : " � :°. °` '
1-�----��Yni'���"---;e--•-I 'o' separafion holween lrenches.
w . e,. . q.
0
1 lighest�Trench ------------------------- Lowest 1"rench (as applicable)
System �levations- �3 ,Z-� ft; , �3 .Z� ft; fl; ft; ft
Cdulck4 Standard-W
w/End cap OhservaUon Plpe TYPICAL TRENCH
-- (typlcal) (Show location of inlet/outlet pipe connection on plan view.) (typlcol)
Inst�ll por manulacturor'S PLAN VIEW
� InsUur.Urnis. � `
i - -- - - --,;- — -- --, - -- — — �� --- - -- . _ __ _ - ��- -- -- — -- --- --- __ .__: - - ,-: -� No Scale� ,i
� , ' '. ', � ( �� ��^(vn� �q 'p
��--'_. .-- �-- - _._ .-- -- --- - - - -�� - -- - -- - --- -- �j�-- -- - - - -=- -- -- - -� �
�__---- - - B = 7� rt ._.__------- -- ------.-� m ,
(typical) Quick4 Standard-W Chamber W I
INSTALL PER TRENCH: (rypicaq �
___ (mfd by Inflllrator Syslems,Inc.) ^1-�
� � Inslall pursuant lo manufaclurers instrucUons. �
� Quick4 Std-W @ 20 f�EISA/chamber= 3� ft2 �
+ � � Pairs of end caps @ 6 itZ EISA/pair= � ft2 ,
= Proposed EISA per trench= ft2 Required Infiltration Area= ��3 ft` Dis11'IbutlOtl Method: il
Lc?�
x 2- trenches = Proposed Total EISA = �, ttZ q rc�� � '
. 6a�
�
PAGE �OF �
In-g�ound Gravity Manac�em�nt Plan
IMPORTANT:
The owner of this in-ground gravity system shal! be responsibie icr its per�etua! operation and maintenance pursuant to
requiremenis of SPS 382-384,Wisc. Admir. Code. Pursuant to SPS 383.b2 (2),Wisc. Admin. Code, this system shall
be considered a humar. health hazard •,�not maintaired in accordance with this aaproved management plan.
Furthermore, al! insoeccion ard mairtenance ac�ivities sha(I be perforrr?ed by a registered POWTS Maintainer in
accordznce with SPS 383.52 (3),Wisc. Adm;n. Code.
Maximum Dispersa! Area Operatinca Limits:
Design Flow= �'S� gpd; 3OD$<_220 mgL"'; TSS <_ 150 mgL''; FOG 5 30 mgL''
' tnsqecfiaon Checklist 4NSPECT EVERY 3 YEARS
o type of use
o age of system
o ruisance fa�tors(i.e. odors. user compiai^ts, etc.)
o mech2nic21 mal�unct�or: (i.e., pumps:va!ves, switcnes, 7oats, etc.)
o maTerial iatigue (i.e., ieaks, breaks, corrosion; eic.)
o solids volume in anaerobic treaiment tank(s)and any distrbution appur�enance(s) (i.e.,distribution/drop boxes)
o neglect or imp!aper use (i.s., exceeding design capacities, prohibited activities, etc.}
o extent of ponding in distribut'son cell prior tc dosing
c dosing irregu!arities-if appiic2ble;;.e., pump re-cycling:float switch setti�gs, etc.)
o efectrical componer,�s-if applicable(i.e., wiring, cornectiors, switches, controls, timers, alarms, efc.)
o distributior. (ateral or fatera( orifice plugging (measure fateral distaf pressure—compare to design specification)
o surface discharge oi eff(uent or sewage back-up into structure served �
Maintenance Checkiist lb3AliVTAlid �VERY 3 YEARS (or when necessary)
c Septic and dose tank;s)sh2if be pumped by a certified septage servicing operator Gcensed under s. 281.48 VI�'is.
Stats.when the volume of solids in the tank(s) exceeds one-third(113)the liquid volume of the tank{s) or
as required by fcc�I ordirance. Disposa! ef contents shall be pursuan#to NR 113,Wisc.Admin. Code.
o Effluent filter(s)shall be irspected every 3 years and shall be cleaned when necessary to remove 2ny
accumula�ed selids according to manuiacturer's speci;icatio^s. A senricing neriod will always be grea:er than 12
mcrths.
�
System maintenance reports shal! be submitted te the proper loca!government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component iaiture or maffunction to:
Name ofindividua! orcompary: �0 .6 �.� �c�.rc'� � � �q Phone: �15 —���— �� 3 �
!ocz� govemment ur.it: Sc-c��r�e� C o �ovi t.�.q Phone: ��5-634 4�52-Sg
Local governmen:unit address: 1� b l G 1Vl,ct..�� S'f � �-I, -�i ��t.ex�rc�. Le.��p; �{FS�{3
Any defective part of this system shaG be repaired, replaced, or removed pursuant to SPS 383.�1 (9),Wisc.Admin.
Code. Repair or replacemert of;aiied or mal*unctioning componerts shall ccmply with SPS 383,Wisc.Admin. Code.
No pred�:ct for cnemical or pnysicai restor2ti�n of:he POWTS may be used uniess approved by the deoartment in
accordance witn SPS 384,Wisc.Admi^. Code.
Continaencv Pian
1n the event th2t any raifed tre2tmen;componer�of this?OWTS c2nnot be�epaired, it sha11 be replaced pursuani to
2 plar submitTed�o tne appropriate agency;or review and 2pprova(. A failed in-g-ound dispersal compor,ent may be
abandoned and rep(aced by a�ade-cornp!ying dispersai componer.i ir, 2 pre-deie�ire� are2 of suitable soils.
SYsterti Abandonment
If use of this POWTS is discortinued: it shai! be abandoned ir accerdance witn SPS 383.33, Wisc. Admir.. Code.
�°' "`�'`'T PRIVATE ONSITE WASTE TREATMENT �ounty
� �»
i>i'o$ � `, sYs-rEms Sawyer
�����;�;�:��'� ( POWTS)
°Frss'°�'�`'` INSPECTION REPORT Sanitary Permit No:
�_ _
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2� —b6.�—
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(i)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
/�� [�rh�.Q, L LC. �ss l..a l,C�- ,.'
Insp BM Elev: BM Description: Parcel Tax No:
•�� Nu► � �"� /�'s,�.. Lb" � w ,1� ooa- qY�-o y- �Yag
TANK INFORMATI N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,�,�e�s— ( p c�vv Benchmark p.'"? (00,'7` (oo„o �
Dosing
Aeration Bldg. Sewer Y (� ' q6 ( �
�
Holding St I Ht Inlet 5.46 � `1`(�7�('
TANK SETBACK INFORMATION St I Ht Outlet 6,3 ` q'`{. '
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic ,�.�� ��� $� .}-$ � NA Dt Bottom
Dosing NA Instaliation
Contour
Aeration NA Header/Man. 6,� � � �
r
Holding Dist.Pipe
PUMP/51PHON INFORMATION Infiltrative �,��� � 2 �5.�
Surface
Manufacturer Demand Final Grade
Motlel Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO ATION
DIMENSIONS �1 � � 6g 6 g #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �...�, �
INFORMATION P�L Bidg Weli Waters o G p� Chamber Model Number:
o EZFIow
CELLTO .�� ��, �-� �t,J o Mound o Other QY�
DISTRIBUTION SYSTEM X Pressure Systems Oniy
Header/Manifoltl Distribution Pipe(s) — X Hole Size X Hole Observation Pipes�
Length Dia Length Dia Spac Spacing �Yes ❑ No
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No�
COMMENTS: (Include code discrepancies, persons present,etc.)
��,...�f(� q ���202
Plan revision required?�Yes❑ No �� �� 2 ` �c,r��� �
�J
Use other side for additional information Date POWTS Inspector's 5ignature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: �,� --0��
. � ._ _ . . . . �
; Z\ --
- -- -• --_:. . __ .. - - -- .. _ __. _ _
_ . , ._ .. _ . _ , _ . , _. . _ ; - � ; . ,
`
, , � .
. . . , .
� ' ; -
; . , : :_
, , , ,
; : _. . �-- � _ �� --_ . __ ---
- _ _._ _ , . . . . -•--- � �_
.. : _ "'� �o t ,
_...._.. ;.__. ,... ._._._. __ _ __.
,
�`,,�\�'Y ; , ,
��Q�e� x�? �. . _ _ . � ;_ �___ -_ . . .;
S� � a ,��- : . _ .. .
�� �� 3
. �.�, _ ,_
�
�-� �
� .
�:��
�.��
�
�c
3�� �
�
� n-,�— �` �,�►, .
_ �d
��